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Algorithm for the treatment of chronic back pain
Last reviewed: 08.07.2025
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The treatment algorithm for chronic back pain is as follows:
- Determining the cause of pain and its pathophysiology;
- Assessment of pain intensity;
- Assessment of the patient's physical and mental state. Consideration of comorbid disorders;
- Monitoring the effectiveness of therapy;
- Prevention and correction of side effects.
In 1998, the WHO proposed the so-called pain relief ladder, which demonstrates the principles of escalating analgesic treatment. Initially proposed for the treatment of cancer pain, this scheme has become universal.
- Non-opioids: aspirin, paracetamol, NSAIDs
- Weak opioids: tramadol, codeine, dihydrocodeine
- Strong opioids: morphine, diamorphine, fentanyl, buprenorphine, oxycodone, hydromorphine
Adjuvants: antidepressants, anticonvulsants, steroids, muscle relaxants (eg, tizanidine, baclofen), bisphosphonates (eg, zoledronic acid, alendronic acid, ibandronic acid), calcitonin, exercise, physiological support, thermotherapy, traditional medicine, hydrotherapy, acupuncture.
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